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The vice-chancellor meeting with an elderly patient, who had undergone the TAVI procedure recently. Photo – Supplied photo
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Muscat: A team of cardiac surgeons and cardiac anaesthetists at Sultan Qaboos University (SQU) Hospital has successfully conducted an advanced surgery for an aortic valve-replacement on four patients aged over 75 years.
The operation, called 'Trans-catheter Aortic Valve Replacement/Implantation' (TAVI), is a minimally invasive approach to implanting an artificial heart valve inside a constricted aortic valve. This approach was designed for patients who cannot be operated for conventional aortic valve-replacement surgery because of the high risk involved.
This is the first time that this heart-valve replacement surgery has been performed in any hospital in the Sultanate. Dr Ali bin Saud Al Bimani, the vice chancellor of SQU, visited the four patients, who have undergone the TAVI surgery at SQU Hospital recently.
Dr Hilal Al Sabti, cardiac surgeon, deputy director general of SQU Hospital for Clinical Affairs, and the leader of the heart surgeons' team, noted that during this valve-replacement surgery, the physician inserts a catheter (a tube) through an artery in the groin (trans-femoral approach) or through a small incision between the ribs (trans-apical approach). "The artificial valve is compressed and fed through the catheter until it reaches the aortic valve. A balloon expands the artificial valve within the patient's diseased aortic valve, and the catheter is removed. The new valve replaces the old, increasing blood flow throughout the body. Trans-catheter techniques allow our team to perform the valve-replacement procedure while the patient's heart is still beating, eliminating the need for a bypass machine and its associated risks," he explained.
Dr Adil Al Kindi, cardiac surgeon, pointed out that in the conventional procedure, or open-heart surgery, the heart must be stopped, and the patient must be placed on a heart–lung machine until the replacement is done.
Open heart surgery
"The incision is also quite large, down the middle of the sternum. Usually, conventional open-heart surgery is not advisable for patients who are at high risk because of old age and other factors. TAVI involves only catheter-based procedures, with the help of fluoroscopy to avoid large incisions," he said.
Dr Mohamed Al Mukhani, senior consultant cardiologist at Royal Hospital, who is also a member of the team of physicians that performed the operation, remarked that even though TAVI is becoming a common procedure in cardiology worldwide, it makes up only a small percentage of all aortic valve-replacement operations. In minimally invasive cardiac surgery, including TAVI, the duration of the patients' hospital stay is short. "In most cases, the patients are discharged on the same day as the surgery," he stated.
Dr Adil Barakat Al Riyami, consultant cardiologist, added that if these patients are sent abroad for this procedure, the cost would be very high.
The physicians observed that conventional open-heart surgery takes at least four to six hours to complete, whereas TAVI is often completed in less than two hours.
Inoperable patients who undergo TAVI have had improved heart function, survival rates, and quality of life compared with patients who do not receive a new valve
and continue with standard medical therapy, such as medicine to treat aortic stenosis and a procedure to stretch the opening of the aortic valve.
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